Provider Demographics
NPI:1376571547
Name:SHERMAN, SHERRY DIANE (RPA-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DIANE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:D
Other - Last Name:RUGENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:1444 WESTERN AVE STE B1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3440
Practice Address - Country:US
Practice Address - Phone:518-489-2812
Practice Address - Fax:518-489-2444
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009359-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02503473Medicaid
Q41311Medicare UPIN
NYPA0742Medicare PIN
NYJ400001307Medicare PIN